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<meta name="description" content="昨天的推文发了以后，有位读者与我联系，交流。问我是否需要预备短斜面。我的确没有想过这个问题，平时临床操作中也很少预备短斜面，认为不必要了。今天搜了一些资料： 1.姜婷（主编）.实用口腔粘接修复技术.人民军医出版社,2008年7月第一版第一次印刷.四类洞，口腔内的暗环境容易影响充填后树脂的色调，暴露于唇侧的切缘容易显示而很明显，解剖学上的要限制了从充填到研磨的一系列操作。为了使复合树脂和牙体的交界面">
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          <h1 class="post-title" itemprop="name headline">复合树脂充填牙体预备边缘斜面的资料</h1>
        

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        <p>昨天的推文发了以后，有位读者与我联系，交流。问我是否需要预备短斜面。我的确没有想过这个问题，平时临床操作中也很少预备短斜面，认为不必要了。今天搜了一些资料：</p>
<p>1.姜婷（主编）.实用口腔粘接修复技术.人民军医出版社,2008年7月第一版第一次印刷.<br>四类洞，口腔内的暗环境容易影响充填后树脂的色调，暴露于唇侧的切缘容易显示而很明显，解剖学上的要限制了从充填到研磨的一系列操作。为了使复合树脂和牙体的交界面不明显，需要在唇侧切缘的牙釉质内赋予常的斜面边角使充填逐渐移行。这种长斜面边角不是直线的，有一些凹凸不平可以使边界更为模糊，不但有边缘线上的不平，深度的变化也可以使光线散射而使边界不清。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0180-bevel/01.png"><br>2.松村英雄,田上顺次（主编）.粘接性复合树脂修复体临床指南.人民军医出版社,2011年1月第一版第一刷.<br>为了使复合树脂和牙体之间形成不明显的、类似自然的边界，应在唇侧边缘的牙釉质内形成长斜面。这个长斜面，并非直线，而是呈现凹凸形态，这会使修复体边缘界限更不明显，这种凹凸不只是平面性的，更有深浅的起伏。凹凸的边缘不只比直线更不明显，在某些情况下还有散射光线的效果。在制备长斜面中使用快速手机时，可以事先用铅笔在牙体上标记斜面的形状。<br>对于游离牙釉质而言，保留的优点大于保留的风险。<br>3.高学军,岳林主编.牙体牙髓病学.北京大学医学出版社,2013年12月第二版第一刷.<br>为了保证色彩的过渡与粘接效果，必要时需制备洞斜面。<br>洞斜面的缺点是窝洞外缘线的终止点不明确，用牙色材料修复时易超填而形成飞边。另外，较薄的充填体边缘受力时易折断，使修复体边缘产生缺陷。所以，承受咬合的部位不制备洞斜面，防止将来充填体边缘部分碎裂。<br>为保证修复体的边缘厚度，明确窝洞外缘线的终止点，防止飞边产生，可采用凹形斜面(hollow-ground bevel)。一般使用杵状金刚砂钻将洞缘釉质厚度的外2/3磨成凹形，使窝洞的外缘与充填体呈90°角的接触关系。凹形斜面既保证了充填体的边缘厚度从而增加了抗力，又可像传统洞缘斜面一样增加了牙釉质的粘接面积，即使在直接受力的部位也可以使用。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0180-bevel/02.png"><br>后牙一类洞，洞斜面的制备虽然可以增加粘接面积，但也磨除了健康的牙体组织，所以要根据临床的实际情况决定。当窝洞较小、洞斜面的位置位于咬合接触区时，过薄的树脂材料很容易在此处折断。<br>二类洞的颊舌侧壁的釉质边缘应制备与表面呈45°角的洞斜面，研究表面，颊舌侧的洞缘斜面可以有效地减少边缘的微渗漏。当龈壁有足够的釉质时可制备短斜面；龈壁接近釉牙骨质界时应与牙长轴垂直而不做斜面。如果在龈壁存在悬釉，可将龈壁制备成内斜面加以保留，以增加龈壁的封闭性。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0180-bevel/03.png"><br>再看几篇论文<br>4.杜礼安,张立亮,马莉等.洞缘角度对树脂充填后微渗漏的影响.中国基层医药,2012年12月第19卷第24期:3691-3692.<br>用离体牙比较了45°、70°、90°洞缘角的树脂充填后的微渗漏，发现70°时微渗漏最小，与其余两者差异有统计学意义。<br>5.郭阳,于翠英,王宏丰.不同洞缘设计的离体牙复合树脂充填后抗折力实验研究.哈尔滨医科大学学报,2005年6月第39卷第3期:279-281.<br>用离体牙比较了45°、70°、90°洞缘角和弧形洞缘设计的树脂充填后的牙体的抗折力，发现采用70°洞缘角离体牙的抗折力要优于其余三者。<br>6.Han L, Okamoto A, Iwaku M.The effects of various clinical factors on marginal enamel micro-cracks produced around composite restoration.Dent Mater J. 1992 Jun;11(1):26-37.<br>用立体显微镜和扫描显微镜研究树脂充填后釉质微裂的产生。研究的因素有不同的固化系统、边缘形式以及抛光的时间。当边缘没有斜面，并且充填后立即抛光时，所有树脂充填体边缘均发现了釉质裂纹。裂纹分布与窝洞边缘大致平行，从边缘延伸0.01-0.3mm。光固化较化学固化材料产生更多的釉质裂纹。对于无斜面边缘，术后10分钟抛光产生的裂纹要多于术后24h抛光。边缘斜面以及延迟抛光能降低釉质裂纹的产生。<br>7.Soliman S, Preidl R, Karl S, Hofmann N, et al. Influence of Cavity Margin Design and Restorative Material on Marginal Quality and Seal of Extended Class II Resin Composite Restorations In Vitro.<br>J Adhes Dent. 2016;18(1):7-16.<br>几位学者用离体牙研究被破坏的牙釉质、盒状洞型和邻面预备斜面的洞型对树脂充填后釉质表面和微渗漏的影响，发现预备短斜面并没有更高的边缘连续的比率，但被破坏的牙釉质应该去除。<br>8.Lopes Coutinho TC1, Almeida Tostes M.Comparison of microleakage of different margin types around Class V resin restorations in primary teeth.Eur J Paediatr Dent. 2013 Sep;14(3):246-51.<br>用离体牙五类洞研究了凹形斜面和直线斜面的树脂充填的微渗漏。凹形斜面洞型能降低边缘微渗漏，但差异并无统计学意义。</p>
<p>总结一下：树脂充填窝洞的洞缘预备短斜面，主要目的是增加粘接面积，提高粘接力，以及前牙充填时边缘过渡更自然，美观性更好。对于前者，现在已无必要，且在咬合面预备短斜面会使树脂层过薄，容易折裂，边缘微渗漏等。早期的观点是要做边缘斜面的，近期的研究认为做不做差异不大。对于前牙美学区域树脂修复，还是有必要预备斜面的。要预备成凹凸不平的边缘。<br>所以，经常分享交流还是有好处的。感谢那位读者！</p>
<p>我发文章的四个地方，欢迎大家在朋友圈等地方分享，欢迎点“在看”。<br>我的个人博客地址：<a href="https://zwdnet.github.io/">https://zwdnet.github.io</a><br>我的CSDN博客地址：<a target="_blank" rel="noopener" href="https://blog.csdn.net/zwdnet">https://blog.csdn.net/zwdnet</a><br>我的博客园博客地址： <a target="_blank" rel="noopener" href="https://www.cnblogs.com/zwdnet/">https://www.cnblogs.com/zwdnet/</a><br>我的微信个人订阅号：赵瑜敏的口腔医学学习园地</p>
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